Assessment of Risk and Need Douglas B. Marlowe, J.D., Ph.D. National Association of Drug Court Professionals.

Assessment of Risk Assessment of Risk and Needand Need

Douglas B. Marlowe, J.D., Ph.D.Douglas B. Marlowe, J.D., Ph.D.

National Association of Drug Court ProfessionalsNational Association of Drug Court Professionals

Exigent RiskExigent Risk• History of violence or dangerousnessHistory of violence or dangerousness– Records checkRecords check

– Interview collateralsInterview collaterals

– GAIN-Q Behavioral Health Scale; TCU Hostility ScaleGAIN-Q Behavioral Health Scale; TCU Hostility Scale

• Substance abuse Substance abuse andand psychosis, combat-related psychosis, combat-related

PTSD, mania or frontal brain injuryPTSD, mania or frontal brain injury– Mental status assessment or psychiatric historyMental status assessment or psychiatric history

– AnyAny substance abuse screen (CAGE, DAST, AUDIT, substance abuse screen (CAGE, DAST, AUDIT, etc.)etc.)

• PsychopathyPsychopathy– PCL-RPCL-R

Risk of Dangerousness ToolsRisk of Dangerousness Tools

• COMPAS Violence ScaleCOMPAS Violence Scale

• Violence Risk Appraisal Guide (VRAG)Violence Risk Appraisal Guide (VRAG)

• Sex Offender Risk Appraisal Guide (SORAG)Sex Offender Risk Appraisal Guide (SORAG)

• Historical-Clinical-Risk 20 (HCR-20)Historical-Clinical-Risk 20 (HCR-20)

• Classification of Violence Risk (COVR)Classification of Violence Risk (COVR)

• Static-99Static-99

Prognostic RiskPrognostic Risk

~ ~ AnyAny validated recidivism risk tool validated recidivism risk tool

Prognostic RiskPrognostic Risk

~ ~ AnyAny validated recidivism risk tool validated recidivism risk tool– Prior criminal historyPrior criminal history

– Current age < 25 yearsCurrent age < 25 years

– Delinquent onset < 16 yearsDelinquent onset < 16 years

– Substance abuse onset < 14 yearsSubstance abuse onset < 14 years

– Prior rehabilitation failuresPrior rehabilitation failures

– Antisocial PersonalityAntisocial Personality

– Criminal valuesCriminal values

– Familial history of crime or addictionFamilial history of crime or addiction

– Criminal associationsCriminal associations

– Instability (chronic homelessness, unemploymentInstability (chronic homelessness, unemployment))

Recidivism Risk ToolsRecidivism Risk Tools

Level of Service Inventory-Revised (LSI-R)Level of Service Inventory-Revised (LSI-R)  Wisconsin Risk and Need Assessment Scale (WRN)Wisconsin Risk and Need Assessment Scale (WRN)  Risk and Needs Triage (RANT)Risk and Needs Triage (RANT)  Correctional Offender Management Profiling for Alternative Correctional Offender Management Profiling for Alternative Sanctions (COMPAS)Sanctions (COMPAS)  Ohio Risk Assessment System – Community Supervision Tool Ohio Risk Assessment System – Community Supervision Tool (ORAS-CST) (ORAS-CST)     Post Conviction Risk Assessment (PCRA)Post Conviction Risk Assessment (PCRA)    

Criminogenic NeedsCriminogenic Needs

• Substance Dependence or AddictionSubstance Dependence or Addiction– Triggered binge responseTriggered binge response– Cravings or compulsionsCravings or compulsions– Withdrawal symptomsWithdrawal symptoms

DSM-5 CriteriaDSM-5 CriteriaSubstance Use Disorder- 2 in 12 months

1. Often taken in larger amounts than anticipated2. Persistent desire or unsuccessful efforts to quit3. Great deal of time obtaining or using the substance4. Cravings5. Failure to fulfill major role obligations6. Persistent social or interpersonal problems7. Important activities given up8. Recurrent use in physically hazardous situations9. Persistent physical or psychological problems10. Tolerance11. Withdrawal

Mild = 2 to 3Mild = 2 to 3Moderate = 4 to 5Moderate = 4 to 5Severe ≥ 6 Severe ≥ 6

}} Must be causal Must be causal

DSM-5 CriteriaDSM-5 CriteriaSubstance Use Disorder- 2 in 12 months

1.1. Often taken in larger amounts than anticipated (i.e. binges)Often taken in larger amounts than anticipated (i.e. binges)2. Persistent desire or unsuccessful efforts to quit3. Great deal of time obtaining or using the substance4. Cravings5. Failure to fulfill major role obligations6. Persistent social or interpersonal problems7. Important activities given up8. Recurrent use in physically hazardous situations9. Persistent physical or psychological problems10. Tolerance11. Withdrawal Mild = 2 to 3Mild = 2 to 3

Moderate = 4 to 5Moderate = 4 to 5Severe ≥ 6 Severe ≥ 6

}} Must be causal Must be causal

DSM-5 CriteriaDSM-5 CriteriaSubstance Use Disorder- 2 in 12 months

1.1. Often taken in larger amounts than anticipated (i.e. binges)Often taken in larger amounts than anticipated (i.e. binges)2. Persistent desire or unsuccessful efforts to quit3. Great deal of time obtaining or using the substance4. Cravings5. Failure to fulfill major role obligations6. Persistent social or interpersonal problems7. Important activities given up8. Recurrent use in physically hazardous situations9. Persistent physical or psychological problems10. Tolerance

11.11. WithdrawalWithdrawal Mild = 2 to 3Mild = 2 to 3Moderate = 4 to 5Moderate = 4 to 5Severe ≥ 6 Severe ≥ 6

}} Must be causal Must be causal

DSM-5 CriteriaDSM-5 CriteriaSubstance Use Disorder- 2 in 12 months

1.1. Often taken in larger amounts than anticipated (i.e. binges)Often taken in larger amounts than anticipated (i.e. binges)2. Persistent desire or unsuccessful efforts to quit3. Great deal of time obtaining or using the substance

4.4. CravingsCravings5. Failure to fulfill major role obligations6. Persistent social or interpersonal problems7. Important activities given up8. Recurrent use in physically hazardous situations9. Persistent physical or psychological problems10. Tolerance

11.11. WithdrawalWithdrawal Mild = 2 to 3Mild = 2 to 3Moderate = 4 to 5Moderate = 4 to 5Severe ≥ 6 Severe ≥ 6

}} Must be causal Must be causal

DSM-5 CriteriaDSM-5 CriteriaSubstance Use Disorder- 2 in 12 months

1.1. Often taken in larger amounts than anticipated (i.e. binges)Often taken in larger amounts than anticipated (i.e. binges)2. Persistent desire or unsuccessful efforts to quit3. Great deal of time obtaining or using the substance

4.4. CravingsCravings5. Failure to fulfill major role obligations6. Persistent social or interpersonal problems7. Important activities given up8. Recurrent use in physically hazardous situations9. Persistent physical or psychological problems10. Tolerance

11.11. WithdrawalWithdrawal Mild = 2 to 3Mild = 2 to 3Moderate = 4 to 5Moderate = 4 to 5Severe ≥ 6 Severe ≥ 6

}} Must be causal Must be causal

Criminogenic Need ToolsCriminogenic Need Tools

Substance Dependence &Abuse Diagnostic ToolsSubstance Dependence &Abuse Diagnostic Tools• Global Appraisal of Individual Needs (GAIN)Global Appraisal of Individual Needs (GAIN)

• Structured Clinical Interview for the DSM-IV (SCID)Structured Clinical Interview for the DSM-IV (SCID)

• Psychiatric Research Interview for Substance and Mental Psychiatric Research Interview for Substance and Mental Disorders (PRISM)Disorders (PRISM)

• Diagnostic Interview Schedule (DIS)Diagnostic Interview Schedule (DIS)

• Texas Christian University (TCU) Drug Dependence Screen-IITexas Christian University (TCU) Drug Dependence Screen-II

• Drug Abuse Screening Test (DAST-20)Drug Abuse Screening Test (DAST-20)

Criminogenic Need Tools Criminogenic Need Tools (cont.)(cont.)

• Mental IllnessMental Illness– Brief Jail Mental Health Screen (BJMHS)Brief Jail Mental Health Screen (BJMHS)– GAIN-Q, GAIN-SS, ASI Psychiatric, etc.GAIN-Q, GAIN-SS, ASI Psychiatric, etc.

• Severe Functional ImpairmentSevere Functional Impairment– Low IQ, disinhibitionLow IQ, disinhibition– Lack of employable skillsLack of employable skills– Poor daily living skills (ADLs)Poor daily living skills (ADLs)

LSI-RLSI-R• Third Generation (3G) toolThird Generation (3G) tool

• Meta-analyses: mean Meta-analyses: mean rr = .36 = .36

– compared to .27 for 2G tools, and .10 for 1G judgmentscompared to .27 for 2G tools, and .10 for 1G judgments

• Kelly & Welsh (2008):Kelly & Welsh (2008):

– N= 276 male drug offenders released from special prisonN= 276 male drug offenders released from special prison

– Return to custody within approximately 15 monthsReturn to custody within approximately 15 months

– Total Score predicted return to custody: Total Score predicted return to custody: rr = .25; = .25; rr22 = .08. = .08.

– Drug & Alcohol Score also predicted return to custody: Drug & Alcohol Score also predicted return to custody:

rr = .16; = .16; rr22 = .04 = .04

LSI-R (cont.)LSI-R (cont.)• Lowenkamp & Latessa (2002):Lowenkamp & Latessa (2002):

– Predictive validity highly variable across different Predictive validity highly variable across different

programs and populationsprograms and populations

• Holsinger et al (2006):Holsinger et al (2006):

– Not predictive for Native Americans Not predictive for Native Americans

• Whiteacre (2006):Whiteacre (2006):

– Higher false positives and false negatives for African-Higher false positives and false negatives for African-

AmericansAmericans

LSI-R (cont.)LSI-R (cont.)

• Fass et al. (2008):Fass et al. (2008):

– Total Score significantly predicted rearrest within 1 yearTotal Score significantly predicted rearrest within 1 year

– AUC = .60; AUC = .60; rr22 = .03 = .03

– Higher false positives for African-AmericansHigher false positives for African-Americans

COMPASCOMPAS

• Fourth Generation (4G) toolFourth Generation (4G) tool

• Fass et al. (2008):Fass et al. (2008):

– 276 males released from halfway houses in NJ276 males released from halfway houses in NJ

– Not significantly predictive of re-arrest within 1 year Not significantly predictive of re-arrest within 1 year

AUC = .53AUC = .53

– Significantly higher false positives and false negatives for Significantly higher false positives and false negatives for

African-AmericansAfrican-Americans

COMPAS (cont.)COMPAS (cont.)

• Brennan et al. (2009) Brennan et al. (2009)

• Northpointe (test developers)Northpointe (test developers)

– 2,328 probationers, both male and female2,328 probationers, both male and female

– Rearrests within Rearrests within ~ ~ 1 to 5 years1 to 5 years

– All but three scales predicted felony recidivism All but three scales predicted felony recidivism

(AUC = .70 in combination) (AUC = .70 in combination)

– Recidivism Risk Index predicted felony recidivism Recidivism Risk Index predicted felony recidivism

(AUC = .70)(AUC = .70)

– Equivalent prediction by gender, race and ethnicityEquivalent prediction by gender, race and ethnicity